What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Nonvalvular atrial fibrillation (n=902). Intervention: Warfarin vs. Valvular atrial fibrillation (control group). Primary outcome: Use of warfarin and anticoagulation control.

What question did this study set out to answer?

To evaluate warfarin sodium utilization and anticoagulant monitoring among nursing home residents with nonvalvular atrial fibrillation according to clinical practice guidelines.

December 1, 1995Archives of Family Medicine

Use of warfarin for nonvalvular atrial fibrillation in nursing home patients

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Key result

Warfarin is underused for stroke prophylaxis in nursing home patients with nonvalvular atrial fibrillation, with only 20% of eligible patients receiving anticoagulation.

Why the study?

What is the prevalence of warfarin use and adequacy of anticoagulant monitoring in nursing home patients with nonvalvular atrial fibrillation?

Key Points

To evaluate warfarin sodium utilization and anticoagulant monitoring among nursing home residents with nonvalvular atrial fibrillation according to clinical practice guidelines.
Conducted a retrospective, multicenter, point-prevalence study across nursing homes in Minneapolis-St Paul, Minn.
Evaluated 902 patients aged 60 years and older, identifying 69 patients with nonvalvular atrial fibrillation (NVAF) and 16 with valvular atrial fibrillation (VAF).
Assessed stroke risk factors, antithrombotic regimens, and laboratory measures including international normalized ratio (INR) and prothrombin time (PT) over a 6-month period.
Nonvalvular atrial fibrillation was present in 7.6% of the 902 patients, with the majority exhibiting high risk for thromboembolic stroke.
Only 20% of NVAF patients without conventional contraindications received anticoagulation therapy.
INR values remained within the recommended therapeutic range only 37% of the time over 6 months, while PT values were in range 52% of the time.

Study Design

Type

Cross-Sectional (n=902)

Multicenter

Yes

Structured PICO

What is the prevalence of warfarin use and adequacy of anticoagulant monitoring in nursing home patients with nonvalvular atrial fibrillation?

Population

902 nursing home patients aged 60 years and older, including 69 with nonvalvular atrial fibrillation (NVAF) and 16 with valvular atrial fibrillation (VAF).

Intervention

Warfarin therapy and anticoagulant monitoring

Comparator

Patients with valvular atrial fibrillation (VAF) or guideline recommendations

Outcome

Prevalence of NVAF, VAF, and risk factors for thromboembolism and major bleeding, use of warfarin and other antithrombotic drugs for AF, anticoagulation control, and the relationship of warfarin dose with the recommended international normalized ratio (INR) and prothrombin time (PT)

Warfarin is significantly underused and poorly monitored for stroke prophylaxis in nursing home patients with nonvalvular atrial fibrillation.

Discussion

No takes yet. Share an insight, caveat, or question.

Implication

May signal care gaps in stroke prevention for frail elderly; leaves open barriers to anticoagulation and monitoring in long-term care.

Cite This Study

Thomas E. Lackner (1995) conducted a cross-sectional in Nonvalvular atrial fibrillation (n=902). Warfarin vs. Valvular atrial fibrillation (control group) was evaluated on Use of warfarin and anticoagulation control. Warfarin is underused for stroke prophylaxis in nursing home patients with nonvalvular atrial fibrillation, with only 20% of eligible patients receiving anticoagulation.

synapsesocial.com/papers/6a16022e7cdde9fcee1275b0 https://doi.org/10.1001/archfami.4.12.1017

Topics

Atrial fibrillation Persistent AF management Anticoagulation in AF

View Full Paper

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Use of warfarin for nonvalvular atrial fibrillation in nursing home patients

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

Topics

Use of warfarin for nonvalvular atrial fibrillation in nursing home patients

Key Points

Study Design

Structured PICO

Discussion

Implication

Cite This Study

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Topics

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